Department of Plastic, Reconstructive and Aesthetic Surgery, University of Rome "Sapienza", Policlinico Umberto I, Viale del Policlinico, 155, 00161 Rome, Italy.
Department of Plastic, Reconstructive and Aesthetic Surgery, University of Rome "Sapienza", Policlinico Umberto I, Viale del Policlinico, 155, 00161 Rome, Italy.
J Plast Reconstr Aesthet Surg. 2014 Feb;67(2):237-43. doi: 10.1016/j.bjps.2013.10.033. Epub 2013 Oct 28.
Carpal tunnel decompression with division of the transverse carpal ligament has been a highly successful procedure for the treatment of carpal tunnel syndrome. The standard longitudinal incision technique, with a long curvilinear incision, has been the optimal treatment procedure for surgical decompression of the median nerve, for many surgeons. The aim of this study was to compare the traditional open carpal tunnel release (TOCTR) technique with the minimal-access carpal tunnel release (MACTR) technique for the treatment of carpal tunnel syndrome (CTS), presenting our experience.
A total of 120 patients eligible for carpal tunnel decompression were recruited into the study. The patients were randomised for treatment allocation, at a 1:1 ratio, resulting in 60 patients in group A, treated by standard TOCTR, and 60 patients in group B, treated by MACTR. To evaluate patients' outcomes we used the Boston Carpal Tunnel (BCT) questionnaire; the formed scar was evaluated according to the Vancouver scale and short- and long-term complications. Statistical analysis was performed by the chi-squared test and analysis of variance (ANOVA); Excel was the program used.
In our series, there was no complication related to the surgical intervention of any injury to nerve, artery or tendon structures. In each section of the BCT questionnaire, patients in group B had significantly better results than patients in group A at both 6 and 12 months' follow-up (p < 0.001). For the Vancouver scar scale, there was a significant difference between two groups' scores; group B patients had significant improvements compared with group A patients.
In our perspective randomised study, MACTR showed statistically significant improvement compared to TOCTR. The patient tolerance is reasonably high and the procedure is compatible with the current minimal invasive trend in surgery.
腕管松解术联合腕横韧带切开术是治疗腕管综合征的一种非常成功的方法。对于许多外科医生来说，标准的纵行切口技术，即长的曲线切口，一直是正中神经减压的最佳治疗方法。本研究旨在比较传统的开放式腕管松解术（TOCTR）与微创腕管松解术（MACTR）治疗腕管综合征（CTS）的效果，介绍我们的经验。
共招募了 120 名符合腕管减压条件的患者参加本研究。患者按 1:1 比例随机分组，A 组 60 例，采用标准 TOCTR 治疗，B 组 60 例，采用 MACTR 治疗。采用波士顿腕管问卷（BCT）评估患者的疗效；根据温哥华量表评估形成的疤痕，并评估短期和长期并发症。采用卡方检验和方差分析（ANOVA）进行统计学分析；使用的程序是 Excel。
在我们的系列研究中，没有任何与手术干预相关的并发症，如神经、动脉或肌腱结构损伤。在 BCT 问卷的每个部分，B 组患者在 6 个月和 12 个月随访时的结果均明显优于 A 组（p<0.001）。在温哥华疤痕量表方面，两组评分差异有统计学意义；B 组患者的评分明显优于 A 组患者。
在我们的随机研究中，MACTR 与 TOCTR 相比显示出统计学上的显著改善。患者的耐受性相当高，且该手术与当前微创手术的趋势相兼容。
